Healthcare Provider Details

I. General information

NPI: 1245548007
Provider Name (Legal Business Name): JEFFREY EDWARD RICHARDSON OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 SANTA BARBARA BLVD
CAPE CORAL FL
33991-2031
US

IV. Provider business mailing address

3401 22ND ST W
LEHIGH ACRES FL
33971-5252
US

V. Phone/Fax

Practice location:
  • Phone: 239-839-3786
  • Fax:
Mailing address:
  • Phone: 239-839-3786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number273161
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT14752
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: